For the third time in barely a month, one of the private community clinics that make up the District's health care safety net faces a financing crisis that its leaders fear could force its closure.
This time, however, the issue is not late reimbursement from the city's HIV/AIDS Administration but that agency's late decision to pull federal funding the Washington Free Clinic has received for nearly a decade. The action reversed previous confirmation that the grant would continue and left the clinic scrambling for support while planning its demise.
The most recent threat to a nonprofit provider has reverberated differently from when the Whitman-Walker Clinic revealed in mid-May that it was unable to meet its payroll because of a cash-flow emergency -- a situation, since resolved, that raised continuing questions about the HIV/AIDS Administration's expertise and efficiency.
Whitman-Walker, which serves the region's HIV/AIDS population as well as its gay and lesbian communities, is a large organization with real estate and programs in the District, Northern Virginia and suburban Maryland. The Washington Free Clinic is, by contrast, a small, homey operation run from a worn second-floor alcove at St. Stephen and the Incarnation Episcopal Church in Mount Pleasant. Founded in 1968, it is the city's oldest low-cost clinic, and those concerned about its endangered future speak of how its history continues to inspire its care.
"It was one of the first free clinics in the United States and part of the whole free clinic movement," noted Council member Jim Graham (D-Ward 1), who is trying to help it. "It's a very spirited, warm, humanitarian place."
The clinic, at 1525 Newton St. NW, gets by on the proverbial shoestring, its staff of 13 and volunteer corps of 50 caring for about 1,450 patients on a $1.2 million budget. Three-quarters of the patients are recent immigrants from Central America and Africa. A tenth are prenatal patients, and another 120 are infected with the AIDS virus. Most earn poverty-level wages.
"The capacity of the other clinics to absorb them isn't there," Executive Director Carolyn Gardner said.
Gardner readily acknowledges the clinic's past shortcomings. For much of its existence, she said, fiscal accountability and patient record-keeping were hardly strengths. There was no third-party billing for medical care, just one of the reasons the clinic was hemorrhaging a $300,000 deficit when Gardner arrived in fall 2001.
The deficit is down to $60,000, the last several budgets have been balanced, and this year, the culture shifted drastically when the clinic implemented a sliding-fee scale. "You have to function as a business," Gardner said. But in the midst of progress came the first harsh blow: In January the clinic learned it had lost out on a federal AIDS grant worth $275,000 annually. And then, in mid-May, came the second blow: City officials, after reevaluating numerous applications, cut the clinic from other federal money despite earlier assurances that it would be funded. That meant another $107,000 gone, with two weeks' notice and no chance of formal appeal, Gardner said.
What's especially galling to supporters like Graham is that the agency, part of the city health department, is likely to have money left over when its fiscal year ends in September. "It's no way to run a railroad," Graham said last week.
D.C. health director Gregg Pane said he's looking closely at the clinic's emergency "with a sympathetic view." Though not promising funds, he talked about the city's obligation to give an organization such as the clinic adequate notice and help with a transition. The clinic's board is scheduled to meet July 11 to decide when its bank-account bottom line could force the lights off and doors shut -- possibly within weeks.
"It will leave a big hole," said Yasmina Castellanos, a former volunteer and worker who first came to the clinic as a scared, unmarried and pregnant teenager. "It will leave a very deep scar."